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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> N <br /> �` �j ' Z X77 <br /> OWNER <br /> :14'0�-1 (, �a1 CL) r e� TELEPHONE J () " 2 L n <br /> O <br /> m <br /> 3 ( a � Not /P PuP M S �� ° <br /> HOME ADDRESS �/ 63 <br /> `, <br /> EMERGENCY/FIRE NUMBER 4 �l ROAD NAME P QJ1Sl1 6 <br /> LEGAL DESCRIPTION (see tax receipt) 35- a)qI k U Csrn V c 0 <br /> m <br /> 0 <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY 0) r <br /> 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION / , u5i n� OL C <br /> STRUCTURE/ADDITION USE: <br /> ✓ <br /> s vra P hP� Ct i`/, 5e�lPtpT. <br /> (Home/Cabin; Commerci usiness; Bedroom; Deck;etc.r 70AIW17� c ( ,\ <br /> �V✓,lt <br /> BUILDING CONTRACTOR: <br /> i <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p = <br /> A in <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ;om <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o <br /> NORTH <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO O <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. o I1111A111 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr ° W <br /> NEEDED. �- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o f <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Od <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. QO <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRRID WATER <br /> ETBACK AREA. / <br /> y ` � C/cf� 7flSG7C It lY f Ore `�T S ' M = W (D m <br /> 6. a m C H . c 3 <br /> - rn <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o.L <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeM <br /> m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information lam <br /> providing in this application. I agree to permit county offici harged with administering county ordinances or other m <br /> authorized person to hav cess o the a escri d ise at any reasonable time for the purpose of inspection. -n E E <br /> CD : <br /> CD <br /> SIGN HERE <br /> (signature o er r Iding co t ) (date) <br /> ZONING ADMINISTRATOR - 0o . ' . . . <br /> w v+ <br /> 'En fn 49� <br /> N NN NN CA(n <br /> O0 0 0 0 0 0 <br /> T WNSHIP PERMITS MAY BE REQUIRED 0 00 0 0 0 0 <br />